Priority Health Business

Diagnostic list 2013 - 2014

This is the diagnostic list that lists the diagnostic procedures for Priority Health
Business policy and must be read in conjunction with:

The policy document for Priority Health Business Base Cover: Major Surgical Module, and any
other policy document(s) for any chosen module(s), and

The acceptance certificate or renewal certificate, and

The Priority Health Business surgical list

The diagnostic procedures on this diagnostic list have been grouped together for customer friendly
use. In addition, descriptions are provided to explain the diagnostic procedures covered under the
relevant modules under Priority Health Business.

This list applies from 1 July 2013 and is reviewed on 1 July every year and may be updated. If your
policy is part of a subsidised health scheme, this list will take effect from your next group anniversary
date.

Pre-approval for claims

It is important that you obtain pre-approval before you have a diagnostic procedure by calling
0800 123 nib (0800 123 642)0800 123 nib. This process will confirm what is covered and what is required for you to make a claim.
Take a copy of this diagnostic list as well as the Priority Health Business surgical list to your doctor
who will be able to tell you if the procedure being recommended is on the list.

If any pre-approved diagnostic procedure leads to a pre-approved surgical procedure during the
diagnostic procedure being performed, the Benefit maximum of that pre-approved diagnostic
procedure will be reviewed accordingly.

Base Cover: Major Surgical Module and Module 1: Other Surgical Cover

In order for any diagnostic procedure undertaken to be covered it must:

appear with a ✓ in the list below for the corresponding Base Cover: Major Surgical Module or
Module 1: Other Surgical Cover (if taken by you), and

relate to a surgical procedure in the respective module, and

be performed within four months of the admission date for that surgical procedure

For example – you have the Base Cover: Major Surgical Module*

Your registered specialist recommends that you have a Bilateral Breast Ultrasound and Breast Fine
Needle Aspiration (FNA). These diagnostic procedures are listed below under the Base Cover: Major
Surgical Module. Within four months of having these diagnostics, a mastectomy surgical procedure
is undertaken. Mastectomy is a listed surgical procedure under Base Cover: Major Surgical Module
and is covered. Because the diagnostic procedures relate to this surgery, they are covered under
the Procedure-Related Diagnostics Benefit in the Base Cover: Major Surgical Module, with a benefit
maximum of $4,000 per insured person, per policy year.

For example – you have Module 1: Other Surgical Cover*

Your registered specialist recommends that you have a Nasendoscopy. This diagnostic
procedure is listed below under Module 1: Other Surgical Cover. Within four months of having this
diagnostic procedure, a septoplasty surgical procedure is undertaken. Septoplasty is a listed
surgical procedure under Module 1: Other Surgical Cover and is covered. Because the diagnostic
procedure undertaken relates to this surgery, it is covered under the Procedure-Related Diagnostics
Benefit in Module 1: Other Surgical Cover, with a benefit maximum of $4,000 per insured person, per
policy year.

Module 2: Cancer and Non-Surgical Hospitalisation Cover

Diagnostic procedures in Module 2: Cancer and Non-Surgical Hospitalisation Cover must be
undertaken in connection with private chemotherapy, radiotherapy or brachytherapy for cancer,
and within the four months immediately before and after the date of treatment or admission to an
approved private hospital.

Module 5: Specialist and Diagnostic Cover

Diagnostic procedures in Module 5: Specialist and Diagnostic Cover covers diagnostic procedures
that do not relate to a covered surgical procedure or fall outside the four months time frame from your
covered surgical procedure or chemotherapy, radiotherapy or brachytherapy treatment.

Exclusions

There are times when a claim may not be covered. Please check your acceptance certificate
or renewal certificate for specific exclusions and your policy document which sets our standard
exclusions. A copy of the policy wording can be downloaded from www.nib.co.nz or contact us on 0800 123 nib (0800 123 642)0800 123 nib.

*This is an example only. Please refer to your policy wording for full terms and conditions of cover.

Breast – diagnostics

Breast Biopsy is removal of a sample of breast tissue for examination
Frozen section is a sample of tissue which is frozen and analysed at the time of operation

Breast

BREAST – Localisation +/- Hookwire/D Wire Biopsy

✓

✓

✓

Breast localisation is determining the site or place of an area of breast tissue with a
Hook or D Wire for a biopsy to be taken

Breast

BREAST – Bilateral Mammography

✓

✓

✓

✓

A specific low dose x-ray used to screen or diagnose conditions of the breast

Breast

BREAST – Ultrasound Mammography

✓

✓

✓

✓

The exposure of the breasts to high-frequency sound waves to produce a picture of the breast tissue

Breast

DIAGNOSTIC – Fine Needle Aspiration

✓

✓

✓

The use of a fine needle introduced through the skin to draw off fluid accumulation or take a sample of breast tissue to review

Breast

BREAST – Sentinel Node Biopsy

✓

✓

✓

A procedure to take a tissue sample

Abdominal and pelvic: colon – diagnostics

Colon

COLON – Sigmoidoscopy

✓

✓

✓

✓

A procedure to see inside the sigmoid colon and rectum using a telescope

Colon

COLON – Colonoscopy & Sigmoidoscopy

✓

✓

✓

✓

A procedure to see inside the sigmoid colon and colon using a telescope

Colon

COLON – Colonoscopy +/- Biopsy

✓

✓

✓

A procedure to see inside the colon using a telescope +/- sampling the tissue

Colon

COLON – Colonoscopy – Total Procedure Cost

✓

✓

✓

✓

A procedure to see inside the colon from the anus to the caecum and beyond if possible using a telescope +/- sampling the tissue

Colon

COLON – Colonoscopy & Gastroscopy

✓

✓

Colonoscopy is a procedure to see inside the colon using a telescope +/- sampling the tissue
Gastroscopy is a procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue

Abdominal and pelvic: stomach and throat – diagnostics

Stomach

GASTROSCOPY – Total Cost Procedure

✓

✓

A procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue

Stomach

STOMACH – Gastroscopy +/- Biopsy

✓

✓

A procedure to see inside the oesophagus and stomach using a telescope +/- sampling the tissue

Throat

DIAGNOSTIC – Oesophagoscopy

✓

✓

A procedure to see inside the oesophagus using a telescope

Throat

THROAT – Pharyngo-Oesophagoscopy

✓

✓

A procedure using a telescope to examine the throat (larynx and pharynx) and the oesophagus

Throat

OESOPHAGUS – Manometry 24 Ambulatory pH Testing

✓

✓

A procedure used to measure the pressure in the oesophagus and stomach and measure the degree of acid present over 24 hour period

Throat

OESOPHAGUS – Oesophageal Motility + 24hr Ambulatory Study

✓

✓

A procedure used to measure the pressure in the oesophagus and stomach over 24 hour period

Throat

OESOPHAGUS – Oesophageal Motility Study

✓

✓

A procedure used to measure the pressure in the oesophagus

Abdominal and pelvic: small bowel – diagnostics

Small bowel

SMALL BOWEL – Capsule Endoscopy Cam Pill

✓

✓

✓

A procedure using a camera and wireless transmitter which is swallowed in a capsule. The camera takes pictures of the small bowel as it passes through

Abdominal and pelvic surgery: gynaecology – diagnostics

Abdomen/Pelvis

DIAGNOSTIC – Laparoscopy – Gynaecology

✓

✓

✓

A key hole procedure to see inside the pelvis and abdomen using a telescope.

Cervix

CERVIX – Colposcopy +/- Biopsy

✓

✓

A procedure to take a tissue sample from the cervix for review

Uterus

UTERUS – Hysteroscopy

✓

✓

✓

A procedure to see inside the vagina, cervix and uterus using a telescope.

A procedure using a radio-opaque dye and x-ray to examine blood vessels

Heart

Cardiac Investigation Group

✓

✓

✓

✓

This is limited to the following diagnostics only.
Electrocardiography (ECG) is a test to trace the electrical activity of the heart. ETT Exercise Stress test is a test to determine function under pressure. Echocardiogram (ECHO) is a sonogram of the heart.
Holter Monitor Ambulatory ECG is a 24 hour monitoring test.

Heart

HEART – Trans Oesophageal Echocardiography TOE

✓

✓

A procedure using high frequency sound waves to provide pictures of the heart valves and chambers combined with doppler ultrasound which evaluates the blood flow across the heart valves

Heart

CT Angiogram

✓

✓

Computerised tomography is an x-ray of blood vessels, arteries and veins

Neck/Limbs

ARTERY – Angiogram Peripheral

✓

✓

A procedure using a radio-opaque dye and x-ray to examine blood vessels usually in the neck, abdomen, pelvis and limbs

Lung – diagnostics

Lung

DIAGNOSTIC – Bronchoscopy

✓

✓

A procedure to see inside the lungs using a telescope

Bone and limbs – diagnostics

Back bone

MRI Spine

✓

✓

Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of body tissue

Back bone

CT Spine

✓

✓

Computerised tomography is an x-ray of the spine

Bone

BONE – Dexa /DXA

✓

✓

✓

A procedure using dual energy x-ray to measure the density of bone

Knee

KNEE – Arthroscopy

✓

✓

A procedure to see inside the knee joint using a telescope.

Limbs

CT Limbs Extremity

✓

✓

Computerised tomography is an x-ray of the legs or arms

Limbs

MRI Limbs Extremity

✓

✓

Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of the limbs

Limbs

NERVE Conduction Studies and Electromyography EMG

✓

✓

A procedure which evaluates the electrical impulses of the peripheral nerves to detect if the signals are functioning

General body sites: the trunk of the human body to include the digestive system – diagnostics

Body

MRI Musculo Skeletal

✓

✓

✓

Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of the skeleton and muscles

Body

CT Musculo Skeletal

✓

✓

✓

Computerised tomography is an x-ray of the skeleton and muscles

Bones

X-RAY – Examinations and Image Transfers

✓

✓

✓

✓

A procedure using electromagnetic radiation to form medical images

Gallbladder

ERCP (Endoscopic Retrograde Cholangio
Pancreatography)

✓

✓

A procedure using a telescope and fluoroscopy to diagnose conditions of gallbladder, bile system and ducts of the pancreas

Soft tissue

Ultrasound

✓

✓

✓

✓

A procedure using high frequency sound waves, sonography, to provide pictures of the inside of the body

Specific body site

E U A – Examination under Anaesthetic

✓

✓

A procedure where a system or organ of the body is examined.
Usually requested where access is invasive or in children where absolute co-operation is required

Trunk

MRI Abdomen or Pelvis or Chest

✓

✓

✓

Magnetic Resonance Imaging scan which uses magnetism and radio waves to form a picture of body tissue of the chest abdomen and pelvis

Trunk

CT Abdomen or Pelvis or Chest (including CT Colon)

✓

✓

✓

Computerised tomography is an x-ray of the chest abdomen, pelvis and large bowel

Nuclear medicine – diagnostics

Bone

BONE – Scintigraphy

✓

✓

✓

A nuclear medicine procedure using a radioactive isotope and external detectors to capture the radiation emitted from the bone

Specific body site

PET Scan

✓

✓

A nuclear medicine procedure using a radiotracer and external detectors to measure the amount of radiotracer absorbed by the body. There is a range of radiotracer used depending on the body site examined. PET scans may be superimposed on CT or MRI scans

Specific body site

Myocardial perfusion test

✓

✓

A nuclear medicine procedure using a radioactive isotope and external detectors to capture the radiation emitted from the function of the heart muscle

Sensory: eyes – diagnostics

Eye

EYE – Ocular CT Scan (OCT)

✓

✓

A procedure used to assess the structures of the eye

Eye

EYE – Visual Fields

✓

✓

An analysis recording of the peripheral visual field is relation to specific eye diseases

Eye

ARTERY – Temporal Artery Biopsy

✓

✓

A surgical biopsy where a small piece of tissue is removed from the temporal artery to review for inflammation

Eye

EYE – Fluorescein Angiography

✓

✓

A procedure for examining the circulation of the retina in the eye using a dye

Otolaryngology (ENT) – diagnostics

Mouth

MOUTH – Intra Oral Biopsy

✓

✓

A procedure to take a tissue sample from the mouth for analysis

Mouth

MOUTH – Ortopantomogram (Panorex)

✓

✓

A dental x-ray scanning the teeth of both the upper and lower jaws

Mouth

MOUTH – Biopsy

✓

✓

A procedure to take a tissue sample from the mouth for analysis

Nose

NOSE – Nasendoscopy

✓

✓

A procedure to see inside the pharynx (throat) and larynx (voice box) using a telescope

Sinuses

CT Sinus

✓

✓

Computerised tomography is an x-ray of the sinuses

Throat

PHAYNX – Pharyngoscopy +/- Biopsy (Nasal Endoscopy)

✓

✓

A procedure to see inside the pharynx (throat) using a telescope

Throat

THROAT – Laryngoscopy +/- Biopsy

✓

✓

A procedure to see inside the larynx (voice box) using a telescope

Upper airways

DIAGNOSTIC – Panendoscopy

✓

✓

A procedure to see inside the pharynx, larynx, upper trachea, and oesophagus using a telescope

Skin – diagnostics

Skin

SKIN – Biopsy

✓

✓

A procedure to obtain a sample of skin tissue for review

Oncology (cancer treatment) – diagnostics

Vein

VEIN – Port-o-cath – Insertion & Removal

✓

✓

Insertion or removal of a plastic tube into a blood vessel for admission of chemotherapy